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Federation of Physicians & Dentists

Alliance of Healthcare and Professional Employees

Information provided here is otherwise known publicly, but because you may not have had the opportunity to do the research yourself, we try to present certain information to you here, in a concise manner, so that you can be informed as you can be.  Nothing that may be provided here is intended to encourage or discourage any action by any physician, nor is it intended as legal advice.

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Keep An Eye On Your AETNA Participation
(Source: amednews.com. June 16, 2008)

As of June 2, 2008, the five-year settlement Aetna had with physicians and multiple medical societies expired. But,  Aetna executives are promising not to abandon the changes the insurer made over the past five years as conditions of a class-action lawsuit settlement in a case involving several health plans. The Federation will be watching closely to make sure that promise is kept.

As you may recall, Aetna was one of numerous plans that settled lawsuits accusing them of developing schemes to underpay physicians, though the plans do not admit to any wrongdoing.

Aetna has issued a list of commitments it said it would make as of June 2. Aetna has specifically committed to  continue the following:
Allowing doctors to leave the network 90 days after giving notice;
Allowing claims submissions up to 120 days after the date of service;
Making its fee schedule available 90 days before any change (it used to be only 30 days notice);
Allowing participation without all-products or gag clauses.

Aetna also promised to maintain its Physicians Advisory Board, which advises the insurer on coding and  reimbursement issues.

“I think it’s pretty clear that most of this stuff is just good business practice,” said Troyen Brennan, MD, Aetna’s chief  medical officer. “ We’ve gotten beyond unhelpful adversarial relationships,” he said. “ We have every intention of  maintaining those worm and collegial relationships.”

OH REALLY!  Indeed, most of this is “just good business sense,” but too often they, and other health plans, need to be reminded.

 
SO, keep a sharp eye on your Aetna participation to see if anything different starts happening. Different from what  you’ve experienced over the past 5 years. If you DO experience changes, contact us immediately and we’ll help you determine the possible outcomes of those changes.

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And What About Your CIGNA Participation?

In our last issue of the Sentinel, we told you about the expiration of CIGNA’s settlement. CIGNA officials also said that they will voluntarily continue to follow some of the business practices changes they agreed to in 2003, but not all of them.

Some practices that were to remain in effect included:

Making fee schedules available (although it would be at your written request, it wouldn’t necessarily be automatic);
Adhering to AMA coding rules and eliminating certain downcoding (this probably means they just won’t do it automatically);
Giving physicians 180 days to file claims;
Not seeking recovery of overpayments more than 12 months old.

 
Some terms CIGNA may NOT or WILL NOT continue:

Providing 90 days notice of amendments, like to fee schedules (they will most likely go back to 30 days, what it was before the settlement) - [AETNA has agreed to continue this];
Following certain medical necessity definitions;
Prohibiting all-products provisions or contracting with rental networks;
Recognizing benefit assignment;
Paying interest on late claims for patients in self-funded plans.

Have you noticed any changes in you CIGNA participation?

Agreements with six other insurers that settled the class-action lawsuit that began in 1999 remain in effect with varying termination dates. More information is available online at homsettlements.com.